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Pharmacology > Q5 - Renal/STI/UTI > Flashcards

Q5 - Renal/STI/UTI Flashcards

1
Q

Complicated vs uncomplicated

A

Complicated = structural/fxnl abnormalities and involve bladder and/or kidneys.
Fever >99.9, CVA tenderness, pelvic or perineal px in men.

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2
Q

UTI in male patients and older adults are considered ________

A

Complicated.

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3
Q

______ most common pathway for UTI
Hematogenous?

A

Ascending up urethra
Coming from outside the bladder (S. Aureus - immunocompromised)
Lymphatic - surrounding systems (bowel infx, retroperitoneal abcess).

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4
Q

Asymptomatic Bacteriuria (organism >=10^5) screening guidelines?

A

Screen pregnant females
Endourological procedures.

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5
Q

Majority of uncomplicated UTIs caused by _______.
___ Nitrites.
Complicated UTI organisms?_____

A

Enterobacterales.
E.coli = 75-95%
Klebsiela
Staph saprophyticus.

Positive. NitrATES usually exist in urine, but some Gram Neg bacteria convert nitrATES into NitrITES.

E.Coli, Klebsiela, Pseudomonas A., enterococcus, Staph aureus.

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6
Q

How is estrogen used to treat UTIs?

A

Post-menopausal women have fewer UTIs than those who are not on therapy.

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7
Q

What factors would increase your risk for MDRO UTI?

A

Past 3 mo:
Any MDRO urinary isolate
Inpatient stay
Broad spectrum anti microbial
Travel to areas with high MDRO rates.

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8
Q

Male UTIs have a _______ treatment course than women

A

Longer.

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9
Q

Complicated UTI - start with 1 IV dose and then 7-10am PO dose.

A
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10
Q

If your patient has an MDRO complicated UTI and is unable to take a FQ, what is a consideration?

A

May need to admit for IV abx

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11
Q

Critically ill complicated UTI therapy?

A

Meropenem, Imipenem AND Vanc.

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12
Q

Urinary Catheters should be exchanged in all patients who have had one in place for ________ and discontinuation is not an option.

A

14days

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13
Q

Acute vs chronic prostatitis

A

Acute 10-14 day course and BPH agents (tamulosin/Alfuzosin)

Chronic 4-12wks + BPH agents.

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14
Q

Nitrofurantoin - MOA, SE, Clinical considerations?

A

Protein synth inhibitors
N/v, brown urine, rash, liver Tox, neuropathy.
Not for CrCL<30ml/min
Can cause hemolytic anemia in pts with G6PD deficiency.

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15
Q

Fosfomycin - MOA, SE, Clinical considerations?

A

Cell wall inhibit.
GPos and GNeg
N/V/D, HypoK, dizziness
DI: Metoclopramide - low UOP
Works against ESBL-producing or carbepenem-resistant enterobactericeae.

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16
Q

FQ Levoflox and Ciproflox - MOA, SE, Clinical considerations?

A

DNA gyrase inhibitors -
GI, long QT, Cdiff, CNS, AAA rupture, hypo/hyperglycemia, liver Tox, tendon rupture, neuropathies.
Renal dose adjust
DI: antacids, iron salts, zinc, other meds that prolong QT
Near 100% bioavailability. Exacerbate muscle weakness in MG (Aminoglycosides do too).

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17
Q

Beta-lactams - MOA, SE, Clinical considerations?

A

Cell wall synth inhibit
D, rash, HA, sz
Renal dose adjustment
DI - allopurinol =rash
Amox/Clav = most common drug-induced cholestatic liver injury (self-resolution)

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18
Q

Cephalosporins - MOA, SE, Clinical considerations?

A

Ceftriaxone = 3rd gen.
Cell-wall inhibit
N/v/d, rash, black tarry stools, sz
DI - PPIs, antacids and H2RA (abx failure)

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19
Q

Carbapenems MOA, SE, Clinical considerations?

A

Inhibit cell wall synth.
N./V/D, HA, rash, SEIZURES, Cdiff.
Renal adjust
DI: Valproic acid - decreased VA concentration.

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20
Q

Groups who are at highest risk for STI

A

15-24yo
Gay and bisexual men
Pregnant people
Racial and ethnic minorities

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21
Q

What is patient-delivered partner therapy?

A

Prescriptions provided for the partner to the patient evaluated.

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22
Q

NAAT test picks up ______

A

Gonococcal and chlamydia - can be run on anal, vaginal, penile, throat swabs.

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23
Q

T/F: Test of cure is never recommended for Gonorrhea or chlamydia.

A

False. Test of cure is recommended for pharyngeal gonorrhea on alternative tx. None for chlamydia
Retest for gonorrhea and chlamydia at 3 months after tx.

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24
Q

T/F: Neonates born to mothers with gonococcal infections also get Ceftriaxone x1dose.

A

True.

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25
Q

Why is chlamydia so prevalent?
Screening?

A

Asymptomatic in men and women.
Annual screen women 25 and under.

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26
Q

What is a concern with treating infants with erythromycin base or Azithromycin for chlamydia infections?

A

IHPS - Infantile hypertrophic pyloric stenosis - projectile vomiting.

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27
Q

Doxycycline - MOA, SE, Clinical considerations?

A

Protein synthesis inhibitor
N/v/d, photosensitivity, IHPS, tooth discoloration, not in pregnancy or breastfeeding.
Administer with Food to increase absorption, don’t take with Ca containing foods and full glass of water and remain upright for 1-2hrs.

28
Q

Macrolides - Azithromycin/erythromycin - MOA, SE, Clinical considerations?

A

Protein synth inhibit
N/v/d, rash, HA, QTc prolongation

29
Q

Primary syphilis - clinical presentation
Secondary
Latent

A

Solitary, painless chancre. 3 weeks after exposure. Heals and goes away and they forget.
Secondary - fatigue, rash, sore throat, hepatitis, renal dysfxn, ocular neuritis or uveitis. W/in a few weeks of infx.
Latent Tertiary is when neurological, cardiovascular and modular skin legions. Early and Late latent are asymptomatic.

30
Q

If your syphilis patient has a PCN allergy, what is recommended?

A

PCN desensitization.

31
Q

Benzathine (PCN) does/does not penetrate CNS spaces

A

DOES NOT

32
Q

What is Jarisch-Herxheimer Reaction?

A

Initial tx of syphilis.
Non-allergic - Fever/HA/myalgia - results of the lysis of spirochetes (syphilis organism). Treat with Tylenol/NSAIDS.
Can cause premature labor in pregnant women.

33
Q

2 Concerns with Trichomonas

A

Adverse pregnancy outcomes
Risk of PID.

34
Q

Trichomonas tx

A

Women: Metronidazole 500mg BID x7days
Men: Metronidazole 2G PO x1 (pregnant women)
Alternate for M/F: Tinidazole 2G PO x1.

35
Q

Metronidazole - MOA, SE, Clinical considerations?

A

Loss of helical DNA structure and strand breakage.
N/v/d, metallic tast, HA, dizziness.
Safe in pregnancy.

36
Q

HPV vaccination starts at ______.\
2 dose series if prior to _____
3 dose if after ____
Name of vaccine?

A

11/12yo
15
15
Gardasil9

37
Q

HPV 6+11 = 90% genital warts.
16+18 = 99% of cervical cancers

A
38
Q

T/F: HPV/HSV is curable.

A

False. Resolution of symptoms is possible.

39
Q

Most genital wart tx for HPV causes the following SE:

A

Burning, scarring, bleeding, local irritation and pain.
The goal of tx is to remove the superficial layer of the wart/virus.

40
Q

Imiquimod, podofilox, sinecatechins,

A

HPV genital wart tx.
Cryotherapy or surgical removal also possible.

41
Q

HSV tx goal:

A

Reduce symptoms and viral loads.

42
Q

Difference between HPV and HSV

A

HPV is more wort like
HSV is fluid filled blister.

43
Q

HSV-1 = oral to oral transmission and cold sores
HSV-2 = sexually transmitted genital herpes.

A
44
Q

Valacyclovir - what’s better about this?

A

Lasts longer, less doses/day and less SE than acyclovir.

45
Q

Acyclovir, Valacyclovir and Famcyclovir are all safe in pregnancy (cat B)

A
46
Q

Clindamycin — rec tx for PID in pregnancy.
MOA, SE, Clinical considerations?

A

Protein synth inhibitor.
Staph toxic type syndrome
Anaerobic, strep and staph.
N/V/D, Cdiff.
Safe in pregnancy.
IV and PO

47
Q

What kind of AKI is caused by dehydration, HF, or liver failure?

A

Pre-renal.

48
Q

What types causes intra renal AKI?

A

Hypertensive emergency, TTP/HUS, glomerular disease, ATN (Acute Tubular necrosis from sepsis, meds, contrast, rhabdo or prolonged prerenal AKI), AIN (acute interstitial nephritis)

49
Q

What things cause post-renal AKI?

A

Ureteral obstruction (usually needs to be bilateral)
Neurogenic bladder, UTI, meds, BPH

50
Q

Drugs that are nephrotoxic? Acronym
Ami ambles cautiously cycling looping near Polly and Radioing the Tack shop for Vacuums.

A

A aminoglycosides
A Amphiterocin B
C Cisplatin
C Cyclosporine
L Loop diuretic
N NSAIDs
P Polymyxins
R Radiologic contrast/dye
T Tacrolimus
V Vanc

51
Q

Management for AKI

A

Hydration, Diuresis and RRT.

52
Q

Too much NS during AKI rectus situation could cause?

A

Hyperchloremic metabolic acidosis, further restricting renal blood flow

53
Q

When are loop diuretics used for AKI?
MOA? SE?

A

Tx of choice for Volume overload AKI
Furosemide, bumetadine, torsemide, ethacrynic acid.
Reduce reabsorption of NaCl in loop of Henle which draws more water to be excreted
Ototoxicity, Sulfa cross sensitivity.

54
Q

Preventing CKD through BP:

Preventing CKD through DM management:

A

1st line is ACE or ARB - monitor SCr and K 2-4weeks post initiation

SGLT2I (canagliflozin, dapagliflozin or empagliflozin) or/and GLP-1 receptor agonist.

55
Q

ACE - end in -pril
Block conversion of angioI to angioII decrease vasoconstriction and aldosterone secretion.
SE =cough, hyper K and low BP

A
56
Q

ARB - -sartan - block angioII from binding.

A
57
Q

SGLT-2I MOA, SE, CI?

A

Inhibit Na-glucose co-transporter 2 in the kidney to reduce glucose reabsorption.
TII DM only
SE: UTIs, increase r/o bone fx, infection of genital area
CI in severe renal impairment

58
Q

GLP-1: MOA, SE, CI

A

Lower blood sugar by mimicking action of hormone called glucagon-like peptide 1 that stimulates the body to produce more insulin when blood sugars rise.
SE N/v/d, hypoglycemia.
CI in pancreatitis.

59
Q

Finerenone: MOA, SE, CI

A

Blocks mineralocorticoid receptor overactivation in kidney, heart and blood vessels.

Reduces r/o sustained eGFR decline, ESKD and CV death.
SE: hyperK.
CI in strong CYP3A4 inhib or adrenal insufficiency.

60
Q

Stages of CKD

A

Stage 1 eGFR >=90
Stage 2 60-89
3A = 45-59
3B = 30–44
4 = 15-29
5 = <15. NEED Dialysis or transplant.

61
Q

BAAM of CKD

A

Bone disorder
Anemia
Arrhythmias
Metabolic acidosis.

62
Q

Patho of hyperPh in CKD

A

HyperPH leads to decreased VitD activation -> hypoCa -> increased PTH stimulation ->Ca resorption from bone.

63
Q

VitD supp in CKD 3+4, and Vit D analogs (increase intestinal absorption of Ca to provide negative feedback to stop PTH stimulation) for CKD5 or kidney failure

A
64
Q

Calcimemetics MOA, SE, CI

A

Cinacalcet, Etelcalcetide
Increse sensitivity of calcium-sensing receptor of parathyroid gland which decreases PTH, Ca and Phos.
SE - hypoCa, n/v/d, muscle spasm, parenthesis, HA, fatigue, depression, bone fx, weakness, limb pain
CI in hypoCa

65
Q

Epoetin Alfa is only effective if _________.

A

Enough iron is present to make the Hgb (RBC). Assess Iron panel prior to starting.

66
Q

Drugs that raise K

A

ACE, ARA, ARB, OCP, bactrim, transplant drugs.

67
Q

3 mainstays of Tx of for HyperK

A

Stabilize the heart - CaGluconate (preferred) + CaCl
Move K intracellular - insulin+ Dextrose, Sodium bicarb if acidosis is present
Remove K - furosemide, Kayexalate, patiromer, Na Zirconium cyclosilicate(Lokelm - preferred in emergencies) all bind K in the GI tract and excrete through stool.
Hemodialysis.

Pharmacology (20 decks)

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